Provider Demographics
NPI:1750658001
Name:CUMBERLAND ASSOCIATES INC.
Entity Type:Organization
Organization Name:CUMBERLAND ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-849-3803
Mailing Address - Street 1:120 COURTHOUSE SQUARE
Mailing Address - Street 2:PO BOX 385
Mailing Address - City:TOLEDO
Mailing Address - State:IL
Mailing Address - Zip Code:62468-9998
Mailing Address - Country:US
Mailing Address - Phone:217-849-3803
Mailing Address - Fax:217-849-3804
Practice Address - Street 1:120 COURTHOUSE SQUARE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IL
Practice Address - Zip Code:62468-9998
Practice Address - Country:US
Practice Address - Phone:217-849-3803
Practice Address - Fax:217-849-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1164633012Medicaid